Provider Demographics
NPI:1598876963
Name:HAGER, ROBERT DAVID (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:HAGER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 HADDON CT
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-5261
Mailing Address - Country:US
Mailing Address - Phone:973-866-2506
Mailing Address - Fax:609-895-8330
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:BUILDING 4, SUITE 201
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-895-8898
Practice Address - Fax:609-895-8330
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00103400363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ068470AG3Medicare PIN
NJP85249Medicare UPIN